March 8, 2019 Edition
This week, Senate and Assembly Committees continued to hold a number of informational hearings focused on a variety of issues, including public health, mental health, and housing. Committee hearings for specific bills are beginning to be set for the coming weeks as the Legislature approaches deadlines in late-April and early-May to advance measures out of committees.
The CHEAC Legislative Committee will hold its second in-person meeting next week to review the second batch of bills that have an impact on local health departments and public health. Additional measures selected for tracking by the CHEAC Legislative Committee will appear in next week’s bill chart. This week’s CHEAC Weekly Bill Chart is available here.
On Wednesday, the Senate Health Committee convened an informational hearing on the public health infrastructure and capacity. The hearing, chaired by Senator Richard Pan, focused primarily on governmental public health and provided a rare three-hour platform for the state and local health departments to discuss their range of responsibilities and the challenges with addressing key public health issues facing Californians.
The first panel of the hearing consisted of leaders from the California Department of Public Health (CDPH). Dr. Karen Smith, CDPH Director and State Health Officer, discussed the broad responsibilities of CDPH, the state’s reliance on local health departments to carry out many of the CDPH functions at the local level, and foundational public health services. She also referenced her previous experience at the local level during a time where local health departments were facing budget cuts and noted that a loss of workforce at the local level is a real threat to public health. Dr. Gil Chavez, Deputy Director of the Center for Infectious Disease at CDPH, discussed the rising rates of infectious disease cases. He noted that over the last decade, California saw a 45 percent increase in reported cases and highlighted the state and local partnership. Susan Fanelli, Chief Deputy Director for Policy and Programs at CDPH, discussed state and local emergency preparedness activities and key examples of response activities such as those related to the H1N1 outbreak. During the discussion between legislators and CDPH, Dr. Smith did note that the state did not have the capacity to respond to local emergencies with boots on the ground and that trained staff at the local level is critical.
The second panel discussed the role of local health departments, our infrastructure, and challenges. Dr. Rob Oldham from Placer County shared the responsibilities of local health departments. Kim Saruwatari from Riverside County illustrated the planning and preparation that goes into local emergency preparedness activities. Dr. Andy Miller shared Butte County’s recent Camp fire experiences and the role public health played in evacuation requests, infectious disease control, and sheltering support. Lastly, Dr. Sharon Balter shared Los Angeles County’s experiences with the 2017 Hepatitis A outbreak and all the activities that went into ensuring the number of cases remained low.
The next panel discussed key undertreated diseases of interest to the Legislature and the challenges with our local capacity in addressing them. The panel included a representative from Planned Parenthood discussing the rising STD rates, the role of Planned Parenthood, and potential impacts of the federal Title X regulations. Dr. Anissa Davis from the City of Long Beach discussed the role of the local health department and the prioritization of cases that occurs due to a lack of resources. Dr. Louise McNitt from Contra Costa County discussed the number of tuberculosis cases in California and the intensive case management provided by local health departments. Kimberly Hernandez from Kern County noted the lack of both community and provider knowledge regarding valley fever and the need for resources for investigations and education. Elsa Jimenez from Monterey County discussed the burden of chronic diseases in California, the cost to the health care system and the need for sustainable funding for prevention activities.
The last panel focused on solutions and investments the State could consider. Trudy Raymundo from San Bernardino County discussed the funding declines since 2007-08 and the need for sustainable and flexible funding. Shamika Ossey, a second-generation public health nurse from Los Angeles County discussed the critical role of public health nurses and need to maintain and grow a viable public health workforce. Megan Crumpler from Orange County talked about the unique role of public health labs, the specialized testing performed, and the capacity to respond rapidly to public health threats. And finally, Haydee Dabritz from Yolo County highlighted technology advances over the last decade to ease compliance with reporting requirements and the need for investments into training and technical assistance in addition to additional staff.
In closing remarks, we were pleased to hear Senator Pan mention the need to figure out both how to fund public health and how to score the downstream costs associated with not doing so. CHEAC is very appreciative of Senator Pan and the Senate Health Committee members and staff for the opportunity to discuss the vital work of local health departments. Those participating did a wonderful job at highlighting the breadth of issues local health departments face, and additional CHEAC Members emphasized statements made earlier in the hearing during public comment.
The agenda and hearing materials can be found here.
A recording of the hearing can be viewed here.
On Wednesday, Governor Gavin Newsom announced the appointment of Mark Ghaly, MD, MPH as the Secretary of the California Health and Human Services Agency (CHHS). Ghaly, a practicing pediatrician, is currently the director of health and social impact for Los Angeles County. He also served as the deputy director of the Los Angeles County Department of Health Services from 2011 to 2018 and was previously the medical director for a San Francisco Department of Public Health clinic from 2006 to 2011.
Ghaly earned his medical degree from the Harvard Medical School and a Master of Public Health degree in health policy from the Harvard T.H. Chan School of Public Health. His residency was completed at the University of California, San Francisco. Ghaly’s appointment requires Senate confirmation.
Additionally, Michelle Baass was reappointed as the CHHS Undersecretary. Baass has served as the undersecretary since 2018 and was previously the deputy secretary of the Office of Program and Fiscal Affairs from 2017 to 2018. Baass has an extensive background in state legislative and policy roles, including with the Senate Budget and Fiscal Review Committee, the Senate Office of Research, and the Legislative Analyst’s Office. Baass earned a Master of Public Policy and Administration from California State University, Sacramento. She was previously confirmed by the Senate in 2018.
The full announcement from the Newsom Administration is available here.
This week, the California Legislative Analyst’s Office (LAO) published a review of the state’s Active Transportation Program (ATP), administered by the California Transportation Commission (CTC) in coordination with the California Department of Transportation (CalTrans). ATP provides funding to infrastructure and non-infrastructure projects that facilitate travelers being physically active through means such as biking and walking. Overall goals of the program are to increase the number of walking and biking trips, increase safety and mobility, and enhance public health.
The Legislature, in approving the 2018-19 budget package, directed the LAO to review aspects of the program including the types of projects funded, locations of funded projects, and benefits provided to disadvantaged communities. The LAO determined that the majority of program funding supports infrastructure projects, such as sidewalk construction or improvements, bike lanes, and crossing signals. Less than a quarter of funded projects were non-infrastructure projects such as educational initiatives to improve bike and pedestrian safety. In assessing project benefits, the LAO determined that nearly 90 percent of projects benefitted disadvantaged communities.
The LAO found significant challenges in making meaningful conclusions about whether the ATP increases bicycling and walking. In the report, the LAO discusses inconsistent data tracking methodologies and reporting processes to accurately capture this information. The LAO goes on to recommend to the Legislature to require better data collection on program benefits from CTC and CalTrans and consider providing more flexibility to metropolitan planning organizations in developing projects in rural regions. The full LAO report is available here.
This week, the Trust for America’s Health (TFAH) and the Well Being Trust (WBT) released results of a new analysis of mortality data from the U.S. Centers for Disease Control and Prevention (CDC), finding that more than 150,000 Americans died from alcohol- and drug-induced causes and suicides in 2017. This amount is more than twice as many deaths caused by the same methods in 1999. From 2016 to 2017, the combined death rate for alcohol, drug, and suicide increased six percent from 43.9 to 46.6 deaths per 100,000 people.
Although this rate is at a historically high level, the increase is lower than the prior two years when there were 11 percent and seven percent increases for 2015 to 2016 and 2014 to 2015, respectively. The TFAH and WBT analysis found that certain groups of Americans and certain areas were disproportionately impacted; among the findings:
- Among those age 35-54, the death rate by alcohol, drug, and suicide was 72.4 per 100,000, which is the highest among all age groups
- For all males, the death rate was 68.2 deaths per 100,000; for all females, the rate was 25.7 deaths per 100,000
- Regionally, 91 West Virginia residents and 77 New Mexico residents per 100,000 died from alcohol, drugs, and suicide. On the low end, 31.5 Texas residents and 34.1 Mississippi residents per 100,000 died from alcohol, drugs, and suicide.
The analysis goes on to further examine the trends in increasing suicide rates, including a significant uptick in suicides by suffocation/hanging and firearm. These rates were proportionally higher among younger people (particularly adolescents), Blacks, and Latinos. However, absolute suicide rates remained highest among males, Whites, and those living in rural areas.
Synthetic opioid deaths were found to have increased 10-fold over the past five years, including a 45 percent increase between 2016 and 2017. The analysis finds that Americans are now dying at a faster rate from overdoses involving synthetic opioids than they did from all drugs in 1999. Synthetic opioid deaths were highest among males, Blacks, Whites, adults ages 18-54, and those living in urban areas. The American West had relatively low rates of synthetic opioid deaths.
The full TFAH and WBT analysis underscored that the life expectancy decreased for the third year in a row in 2017 due in part to the significant increases in death rates from alcohol, drugs, and suicide. The increases in death from synthetic opioid overdoses and suicides were particularly alarming, according to the analysis.
TFAH details a number of recommendations for prevention and resiliency strategies, including expanding substance misuse prevention programs, promoting hard reduction and treatment activities, limiting access to lethal means of suicide, and expanding crisis intervention and support for at-risk populations. The full report, an update to TFAH’s Pain in the Nation series, is available here.
The University of California, Davis Violence Prevention Research Program (VPRP) What You Can Do Initiative has released an educational video to equip health care providers with information and skills to engage in clinical strategies for reducing firearm injury and death.
According to VPRP, assessing firearm injury and death risk and discussing with patients their access to firearms remain uncommon in practice. A majority of providers have never been educated on prevention of firearm injury and death during their medical training. The new video, “Preventing Firearm Injury and Death: A Targeted Intervention,” introduces providers to their role and details steps for identifying and discussing risk and safety when clinically appropriate. The full video, which includes the opportunity for continuing medical educational (CME) credit, is available here.
The California Department of Public Health (CDPH) Office of Oral Health (OOH) Evaluation Team has announced a webinar on the OOH evaluation resource guide (ERG) and how to use the guide effectively. During the webinar, presenters will familiarize participants on why the ERG has been developed, who can use the ERG, what the ERG contains, criteria used in developing the ERG, and other resources and tools available in the ERG.
The webinar will occur on Wednesday, March 20 from 1:30 pm to 2:30 pm. Additional information and registration is available here.
The National Association of County and City Health Officials (NACCHO) will host a webinar on Wednesday, March 13 from 5:00 pm to 6:00 pm on increasing local health department capacity to implement Health in All Policies (HiAP) initiatives. The webinar will feature local health department presentations on capacity-building activities, discussion around challenges, and peer-to-peer sharing of best practices. Registration is available here.
The National Association of County and City Health Officials (NACCHO), with support from the U.S. Centers for Disease Control and Prevention (CDC) Division of STD Prevention, has announced a funding and program opportunity for five STD clinics to form the STD Express Data Collaborative. STD express services refer to triage-based STD testing activities without a full physical examination. The goal of the STD Express Data Collaborative is to: 1) further establish the evidence base for STD express services; and 2) support quality improvement of established express models.
Selected sites will receive $30,000 each to refine an evaluation plan collaboratively, collect site-level data and share with NACCHO and CDC for analysis, discuss implications of the analyzed data, and explore using the express models to support the scale-up and replication of promising practices.
STD clinics that have been operating STD express services for a minimum of three months are welcome to apply to participate. NACCHO will host an informational webinar for potential applicants next Wednesday, March 13 at 6:00 pm PST. Additional requirements and full details of the project are available here.
The 2019 CHEAC Annual Meeting will be held on October 9 – October 11 in Pasadena and will provide local health department leadership and staff throughout the state with networking and learning opportunities. This year’s conference theme is “Strengthening the Public Health Infrastructure” and will once again feature expanded workshops offered to attendees by collaborating with key partners to host innovative and exciting workshop sessions. Approximately 15 workshops will be hosted between 10:00 am and 4:00 pm on Wednesday, October 9 and Thursday, October 10.
Interested parties may submit workshop abstract proposal to CHEAC by COB on Friday, March 29. Additional information on workshop opportunities is available here.